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21 February 2024

Study shows discrimination and ethnic inequalities among NHS staff during the pandemic

New research led by King’s College London, which surveyed over 4500 NHS staff in England, has found that staff from Black, Mixed and ‘Other’ ethnically minoritised groups were more likely to face difficulties accessing personal protective equipment (PPE) and experience harassment and discrimination from staff during the pandemic compared to their White British colleagues.

nhs covid pandemic healthcare

The study, supported by Wellcome and the ESRC Centre for Society and Mental Health, also showed that these negative workplace experiences were linked to poorer levels of physical and mental health. The unavailability of PPE was associated with an approximate twofold increase in depression and anxiety, whilst harassment and discrimination were associated with a threefold increase. Greater awareness of employment rights around redeployment and greater involvement in redeployment decisions were linked to better mental health outcomes.

The study was published in BMJ Occupational & Environmental Medicine.

First author, Dr Rebecca Rhead, Lecturer in Society and Mental Health at the Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London said: “Throughout the different stages of the COVID-19 pandemic, NHS staff have navigated exceedingly difficult working conditions. Findings from this study suggest that staff from ethnically minoritised groups have also had to endure greater levels of harassment, discrimination, and a notable lack of PPE compared to their White British colleagues.”

Our findings align with recent data from the NHS staff survey and the UK-REACH study, painting a consistent picture of the challenges faced by ethnically minoritised groups within the NHS. These challenges will likely negatively impact their health and wellbeing, but also the quality of care they provide. Moreover, these challenges have implications for their career progression and intentions to remain in the NHS.”

Dr Rebecca Rhead, Lecturer in Society and Mental Health at King's IoPPN

These findings were derived from the Inequalities Survey, co-developed with the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) project, a national stakeholders group, and NHS peer researchers. Survey participants included 4622 NHS staff from across 18 NHS Trusts in England between February and October 2021. The aim of the survey was to identify inequalities in workplace experiences while also collecting standard physical and mental health measures.

Nearly a quarter of all survey participants reported symptoms suggesting probable depression (23 per cent), while 18 per cent appeared to have probable anxiety, and 23 per cent experienced medium to severe somatic symptoms. One-third of the sample reported experiences of bullying and harassment from other NHS staff.

Based on findings from the Inequalities Survey, researchers at the IoPPN have called for urgent structural changes to ensure that all NHS staff are supported. For example, more could be done to ensure NHS staff are educated on their employment rights, allowing them to advocate for themselves. Additionally, culturally safe spaces should be provided for staff to engage in discussions, provide feedback, and question decisions concerning their working conditions without fear of repercussions.

The authors stressed that it is essential to hold trust leadership accountable for these changes, rather than relying solely on managers who often possess limited authority to address trust-wide concerns, and in some situations, may be contributing to the problem.

The findings of this study linking harassment and discrimination to physical and mental health in NHS staff demonstrate the need to address racial discrimination as not only an ethical imperative but a public health issue. We need deep-seated approaches to tackle the systemic nature of racism, and robust processes to combat its key mechanisms and accountability at all levels of management and leadership. Part of this involves effective and transparent monitoring and frameworks that enact structural, organisational and cultural change.

Professor Stephani Hatch, senior author on the study and Professor of Sociology and Epidemiology at King's IoPPN

The Inequalities survey was part of the broader NHS CHECK study, which aimed to assess the mental health and wellbeing of NHS staff during the pandemic.

'Ethnic inequalities among NHS staff in England - workplace experiences during the COVID-19 pandemic' (R. Rhead, L. Harber-Aschan, J. Onwumere, C. Polling, S. Dorrington, A. Ehsan, S. A. M. Stevelink, K. Khunti, G. Mir, R. Morriss, S. Wessely, C. Woodhead, S. L. Hatch) was published in BMJ Occupational & Environmental Medicine (DOI: 10.1136/oemed-2023-108976).

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In this story

Professor Stephani Hatch

Vice Dean for Culture, Diversity & Inclusion

Rebecca Rhead headshot

Lecturer in Society and Mental Health